Cost-Effectiveness Analysis of Treatment with Liposomal Amphotericin B versus Conventional Amphotericin B in Organ or Bone Marrow Transplant Recipients with Systemic Mycoses

1992 ◽  
Vol 2 (6) ◽  
pp. 500-508 ◽  
Author(s):  
Ulf Persson ◽  
Gunnel Ragnarson Tennvall ◽  
Stina Andersson ◽  
Gunnar Tyden ◽  
Bjorn Wettermark
Keyword(s):  
Bone Marrow ◽  
Cost Effectiveness ◽  
Amphotericin B ◽  
Bone Marrow Transplant ◽  
Liposomal Amphotericin ◽  
Marrow Transplant ◽  
Cost Effectiveness Analysis ◽  
Liposomal Amphotericin B ◽  
Transplant Recipients ◽  
Effectiveness Analysis

Possible Liposomal Amphotericin B–Induced Nephrogenic Diabetes Insipidus

2003 ◽  
Vol 37 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Todd W Canada ◽  
Lisa M Weavind ◽  
Kristan M Augustin
Keyword(s):  
Bone Marrow ◽  
Diabetes Insipidus ◽  
Amphotericin B ◽  
Bone Marrow Transplant ◽  
Serum Sodium ◽  
Liposomal Amphotericin ◽  
Nephrogenic Diabetes Insipidus ◽  
Marrow Transplant ◽  
Liposomal Amphotericin B ◽  
High Dose

OBJECTIVE To report the development of nephrogenic diabetes insipidus (NDI) associated with the use of high-dose liposomal amphotericin B. CASE SUMMARY A 38-year-old white man with relapsed acute myelogenous leukemia underwent a matched unrelated donor allogeneic bone marrow transplant with adequate engraftment and mild graft-versus–host disease responding to corticosteroids. Approximately 11 months after transplant, the patient was admitted to the hospital with suspected fungal pneumonia and started on liposomal amphotericin B (baseline serum creatinine 1.4–1.5 mg/dL). The dose was increased due to his immunosuppression and poor response, as the fungal etiology was identified as Torulopsis glabrata. The patient required mechanical ventilation due to biopsy-proven bronchiolitis olbiterans organizing pneumonia. Additionally, he developed diffuse alveolar hemorrhage and received intravenous desmopressin, with a reduction in bloody secretions. He also developed hypernatremia (serum sodium 155 mEq/L) on day 3 of the desmopressin and had an inappropriately increased urine output consistent with NDI. The most likely etiology for the NDI was liposomal amphotericin B and its associated hypokalemia. DISCUSSION The observation of worsening hypernatremia (serum sodium increased from 135 to 164 mEq/L) with polyuria was associated with an increasing cumulative dosage of liposomal amphotericin B for fungal pneumonia despite the concurrent use of intravenous desmopressin. Aggressive water replacement was an effective treatment option in this patient. The Naranjo probability scale classified this as a possible adverse reaction because of the temporal sequence of NDI after high-dose liposomal amphotericin B and previously reported cases of NDI associated with amphotericin B desoxycholate. CONCLUSIONS Amphotericin B desoxycholate has been implicated as an etiology for NDI, and the use of the newer liposomal amphotericin B reportedly avoids this rare complication. We observed the development of NDI despite the use of liposomal amphotericin B in a critically ill patient with bone marrow transplant.

scholarly journals Cost-Effectiveness Analysis of Empiric Liposomal Amphotericin B Versus Voriconazole in Turkey

2013 ◽  
Vol 16 (7) ◽  
pp. A356
Author(s):  
S.J. Turner ◽  
E. Senol ◽  
A. Kara ◽  
D. Al-Badriyeh ◽  
D.C. Kong ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Cost Effectiveness Analysis ◽  
Liposomal Amphotericin B ◽  
Effectiveness Analysis

Effect of Infusion Rate on Amphotericin B-Associated Febrile Reactions

1988 ◽  
Vol 22 (10) ◽  
pp. 769-772 ◽  
Author(s):  
John D. Cleary ◽  
Daniel Weisdorf ◽  
Courtney V. Fletcher
Keyword(s):  
Bone Marrow ◽  
Amphotericin B ◽  
Bone Marrow Transplant ◽  
Cardiac Disease ◽  
Infusion Rate ◽  
Adverse Reactions ◽  
Fungal Infections ◽  
Marrow Transplant ◽  
Transplant Recipients ◽  
Axillary Temperature

Our objective was to prospectively study febrile and chill reactions associated with two amphotericin B (AB) infusion rates, slow (2-hour) versus rapid (45 minute). Seventeen consenting bone marrow transplant recipients in whom AB was to be initiated for documented or suspected fungal infections were recruited. After standardized premedication, patients received eight daily AB infusions (0.5 mg/kg/d, concentration 0.25 mg/ml). Rate was assigned using a randomized, crossover pair design. Axillary temperature, chills, and meperidine dose required to resolve chills were monitored for each infusion. For the first pair of infusions, fever (defined as a rise of 1 °C) occurred frequently, in 12 of 17 (70.5 percent) and 13 of 17 patients (76.4 percent), with a mean rise of 1.7 °C (range 1.1–3.7) and 1.7 °C (1.1–3.5) degrees for the 45-minute and 2-hour infusions, respectively (p > 0.10). Chills were observed in 15 of 17 (88.2 percent) and 14 of 17 (82.3 percent) recipients of the 45-minute and 2-hour infusions, respectively. The time of onset (p > 0.10) and the duration of chills (p = 0.08) were similar for both infusion rates. Meperidine requirements for rapid and slow infusions were similar as well (p = 0.12). These data suggest that for patients free of preexisting renal and cardiac disease, rapid AB infusions are well tolerated and produce adverse reactions (fever and chills) similar in nature and severity to slower infusions.

Sign in / Sign up

Export Citation Format

Share Document